New report on public health: Saving a lost decade

November 11, 2020

The Policy Exchange has outlined how a new proposed deal for public health could help to build a healthier nation.

The deal is outlined in the Policy Exchange’s report, Saving a lost decade, which aims to provide some of the answers that have been central to parliamentary discussion and debate during the COVID-19 pandemic. Questions such as, what is the most effective way of protecting and funding those in social care? How can we lock in the technological gains from the pandemic? And, is the NHS accountability structure the right one for responding to global pandemics?

Senior Fellow and Health and Social Care Lead at The Policy Exchange, Richard Sloggett is heading up the report, and claims that new analysis undertaken by the think tank has revealed the wider consequences of continued inaction on health improvement and prevention.

This first public health report from Policy Exchange specifically looks at the structures of the public health system and improvements that can be made following the news of changes to Public Health England (PHE). It does not go into details on the specific policy interventions that are needed to improve public health and prevention, stating that this is a consideration for future research.

The newly-pitched policy ideas reference the Prime Minister’s manifesto promise that Government would work ‘for everyone to have five extra years of healthy independent life by 2035 and to narrow the gap between the richest and poorest.’ The COVID-19 pandemic has made this goal even more important, says the think tank.

According to The Policy Exchange, the virus has starkly exposed how a lack of action on prevention and population health improvement has compromised our nation’s health, especially in our most vulnerable communities. Obese people have a 50% higher risk of dying and people who smoke, are inactive, have diabetes or coronary heart disease are all at greater risk.

An element of the report is the Policy Exchange’s Build Back Better Programme, which outlines six recommendations:

  1. Ambition – The Government should make improving the health of the nation a new national mission and publish a public health strategy/white paper setting out how to deliver five healthier life years by 2035 including targets and milestones to deliver on this long term goal.
  2. National structures – The majority of PHE’s health improvement functions should move into the Department of Health and Social Care. (DHSC) with closer Ministerial accountability. A new National Institute for Health Improvement should be established linking health improvement to wider ambitions for Government ‘levelling up’. Screening and disease registries should move to relevant NHS organisations.
  3. Funding – The Government should maintain the Public Health Grant as the primary mechanism for funding public health through local authorities but review the amount of money against services and population health need. HM Treasury should regularly review the public health impacts of fiscal events and consider a future uplift formula for public health funding linked to inflation, GDP or the NHS.
  4. Local government – Local authorities should continue as lead public health commissioners, taking steps to find the right structures to work collaboratively with changing NHS systems. Regional public health leaders should be maintained within NHS regional offices.
  5. NHS – NHS integrated care systems in their assurance plans should set out how they are ensuring the voice of place in their regional plans and set ambitious targets on health improvement and prevention in priority policy areas.
  6. System working and performance – The new National Institute for Health Improvement should have stronger working relationships with local authority public health leaders to ensure an acceleration of improvement in public health as a result of increased funding. New population health data captured through NHS and public health outcomes frameworks, underpinned by the new NHS data strategy and a future health index should be used to improve performance and outcomes.

Richard Sloggett said, ‘We find that the Government is in danger of a lost decade of health, with ambitions to meet a manifesto target of increasing healthy life expectancy by five years by 2035 well off track. In this report, we argue that the decision to remove health protection functions from Public Health England to a new National Institute for Health Protection presents an opportunity to reimagine and design a better public health system.’

Read the full report: Saving a lost decade.


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